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Bouttoniere Deformity - Finger Deformity

Introduction

A boutonniere deformity occurs when the tendon that straightens the middle joint of your finger is injured, weakened or stretched.  The injury allows the middle finger joint to bend (flex) and the end finger joint to pull back and hyperextend.  This makes the finger appear crooked. 

A boutonniere deformity can cause pain and loss of function.  Treatments include splinting, hand therapy, and surgery.  Conditions that are treated promptly tend to have the best outcomes.

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Anatomy
Your fingers are made up of three bones called phalanges.  Two joints separate the phalanges.  The distal interphalangeal (DIP) joints are located near your fingertips.  The proximal interphalangeal (PIP) joints are located in the middle of your fingers.  The extensor tendons allow your fingers to extend and straighten. 

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Causes
A boutonniere deformity occurs when the extensor tendon attachment at the central slip on the middle phalanx is injured.  The PIP joint is not able to straighten and remains bent (flexed).  The DIP joint is pulled back into hyperextension by the extensor mechanism that has become out of balance.  This results in a crooked and poorly functioning finger. 
 
Arthritis, burns, Dupuytren’s contracture, and injuries, can disrupt the extensor tendon.  The tendon may partially or completely tear.  The extensor tendon can remain intact but pull a piece of bone away from where it attaches on the phalanx.  This is called an avulsion fracture.

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Symptoms
A boutonniere deformity can cause your PIP joint to feel painful and swollen.  You may not be able to straighten out your PIP joint.  Your DIP joint may be hyperextended, causing your finger to look crooked.

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Diagnosis
Your doctor can diagnose a boutonniere deformity by examining your hand.  X-rays will be taken to check for fractures and the condition of the joints.

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Surgery
Surgery may be necessary to reconstruct a tendon or joint.  If past treatments and surgery fail, the bones in the finger can be surgically fused together and kept from moving. 

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Treatment
Some boutonniere deformities can be treated with splinting.  Splinting can help certain new and old injuries.  Splinting is usually tried for at least six weeks.  All types of surgeries are followed by splinting and hand therapy.  There are many types of splints for boutonniere deformities.  A therapist can customize your splints and provide hand therapy.  
 
Therapy is especially important to ease symptoms and help you regain function.  Initially, your therapist will help you gently move your joints, as they may be stiff and sore after immobilization or surgery.  The passive movement will help reduce discomfort and swelling.  When your hand has healed, your doctor will advance your therapy orders to include strengthening, flexibility, and coordination exercises.  It will be important to work on your hand grip and finger pinching skills.  Your therapists may recommend assistive devices and precautions to use during your regular activities to help prevent future injuries.

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Recovery
Recovery from boutonniere deformity surgery can take three to four months.  It can take up to six months for a full recovery. Recovery is individualized and your doctor will let you know what to expect.

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Prevention
You should contact your doctor if you notice you are developing a boutonniere deformity.  In most cases, early treatment is associated with the best outcomes.  Following treatment, your  therapist can recommend ways to perform your regular activities to help you avoid future injuries. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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